A 20-year-old man has a 12 cm type CE1 hydatid cyst in segment VIII of the liver. Before planning PAIR (puncture, aspiration, injection, reaspiration), MRCP is performed and shows a small communication between the cyst cavity and the right hepatic duct. PAIR should be abandoned in this patient primarily because:
- A Leakage of the scolicidal agent into the biliary tree can cause sclerosing cholangitis ✓
- B Cysts larger than 10 cm cannot be treated by PAIR
- C PAIR increases the risk of anaphylaxis compared with open surgery in all cases
- D PAIR is ineffective against Echinococcus granulosus
Correct answer: A. Leakage of the scolicidal agent into the biliary tree can cause sclerosing cholangitis
Explanation
Communication between the hydatid cavity and the biliary system is a recognized contraindication to PAIR, because hypertonic saline or alcohol instilled into the cyst can escape into the bile ducts and produce chemical sclerosing cholangitis. Such patients need surgery with careful obliteration of the cysto-biliary communication. Large size alone is a relative consideration, and PAIR remains effective against viable Echinococcus cysts.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.